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POLIO END GAME – GLOBAL PERSPECTIVE

POLIO END GAME – GLOBAL PERSPECTIVE. A.Parthasarathy. Egyptian Stele (1403 – 1365 B.C.). What exactly is polio eradication?. (John TJ. Frontiers in Pediatrics 1996; NEJM 2000). Polio Eradication Initiative: Progress 1988-2012. 1988 350,000 cases 125 countries. 2012* 96 cases

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POLIO END GAME – GLOBAL PERSPECTIVE

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  1. POLIO END GAME – GLOBAL PERSPECTIVE A.Parthasarathy

  2. Egyptian Stele (1403 – 1365 B.C.)

  3. What exactly is polio eradication? (John TJ. Frontiers in Pediatrics 1996; NEJM 2000)

  4. Polio Eradication Initiative: Progress 1988-2012 1988 350,000 cases 125 countries 2012* 96 cases 4 countries *Data as of 17th July, 2012

  5. Polio Eradication Challenges Maintaining immunity Maintaining surveillance Readiness to respond Reducing risk Building on Wpv /cVdpv transmission cessation/eradication Preparing for the endgame

  6. Risks Importing WPV Development of cVDPVs

  7. wild virus type 1 wild virus type 3 endemic countries ongoing importation Global Spread of Wild Polio Virus 2003 - 2011

  8. China 2004 DOR/Haiti 2000-01 Niger 2006 Ethiopia 2008-2010 Philippines 2001 Myanmar 2006-07 Nigeria 2005-12 DR Congo 2008-2012 Madagascar 2001-02; 2005 Indonesia 2005 598 circulating Vaccine-derived Polioviruses, 2000-12*17 countries, 20 outbreaks Cambodia 2005-06 cVDPV type 1 (79 cases) 6 outbreaks with cVDPV1 12 outbreaks with cVDPV2 2 outbreak with cVDPV3 cVDPV type 2 (510 cases) cVDPV type 3 (9 cases) Data in WHO/HQ as of 7th August, 2012

  9. Preparing for the endgame

  10. Recent developments • SAGE Nov 2011: recommended that the endgame strategy be based on phased rather than simultaneous Sabin strain removal • WHO Executive Board Jan 2012: requested Director-General to develop comprehensive endgame strategy and timeline based on phased Sabin strain removal • SAGE Apr 2012: may consider an 'early switch' (by Apr 2014), preceded by universal introduction of at least 1 dose of IPV (ID or IM) at DPT3 contact.

  11. 'Endgame' Following the WHO Executive Board resolution of January 2012 endorsing eventual replacement of tOPV with bOPV globally, member states should start preparing appropriate policies, esp. on the role of IPV, guided by and considering the global recommendations of SAGE.

  12. 'Endgame' planning (1) • The national immunization programme should now begin incorporating into its planning: • an eventual tOPV-bOPV switch globally, potentially as early as April 2014, and • eventual cessation of all remaining bOPV globally at some point in the future (e.g. 2017-18 period).

  13. 'Endgame' planning (2) • This planning should include consideration of the introduction, in advance of a tOPV-bOPV switch, of at least one dose of IPV (e.g. at DPT3 contact), to boost population immunity thereby reducing the risk of a type 2 cVDPV emergence & the consequences of a potential cVPDV.

  14. SUMMARY • According to GPEI’s IMG recommendations a new 'endgame' strategy could accelerate eradication, boost routine immunization & reduce long-term risks • Depending on IPV price, the new 'polio endgame' could be cost-neutral in the near term & cost-saving in the long term(No.of doses 1/2/3 in the NIP IM/ID) • Next steps (by Nov 2012): • Further cost-effectiveness analysis by Individual Nations(Affordable IPV IM/ID) • Consultation with with (a) Regional & National authorities on policy & program implications, (b) regulators & manufacturers on licensing & supply. • Consolidation of a draft Polio Endgame Strategic Plan replacing tOPV with bOPV 1&3 to start with and finally phasing out bOPV with affordable All IPV schedule & Budget for the time line of 2013-18 • Feasibility introducing cost effective Hexavalent DTPw-HB-Hib-SabinIPV in the NIPs of developing countries.

  15. Polio Endgame Strategy-India, Potential Timeline tOPV-bOPV switch Polio certification Last WPV case NID NID NID NID NID NID NID NID Post-switch VDPV type 2 risk mgt. IPV intro? Modelling, Research, Development Certification standard surveillance, improved RI coverage 0 Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May 2011 2012 2013 2014 tOPV NID

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